Government of Zimbabwe RBF Presentation December 13 2012 from Zimbabwe Results-Based...It all...
Transcript of Government of Zimbabwe RBF Presentation December 13 2012 from Zimbabwe Results-Based...It all...
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The health sector experienced its most severe crisis in 2008/2009, resulting in development of the 100 Day Plan for Health in March 2009. The National Health Strategy (Equity and Quality in Health: A People’s Right) was developed by the end of 2009. The Health Sector Investment Case was launched in mid‐2010 in an effort to quantify financial gaps and attract resources to the health sector. This led to a number of financial initiatives, including the formation of the Health Transition Fund as a multi‐donor basket fund to support MNCH and health systems.
Data for the NIHFA was collected between the end of 2011 and early 2012. As such, the NIHFA data provide a snapshot of equity and quality in Zimbabwe’s public health system relatively early in the process of active reconstruction and can act as a good baseline for reconstruction efforts.
During 2012 a great deal has already been happening as a result of multiple initiatives (including HTF, RBF). As such it is likely that some of the gaps identified in the data are already in the process of being filled – but by no means all!
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Performance contract definition comes from our RBM training manual
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It all started with Results Based Management. RBF came in to help improve the indicators as defined in the RBM framework. The RBF programme began in July 2011 in two front runner district, Marondera and Zvishavane, with a total of 28 health facilities. 16 more districts were added in March 2012. The programme now covers 8 rural provinces, 18 districts and 387 health facilities. A joint technical RBF programme review was done for the first nine months of implementation front runner districts , findings from the review were used to improve the programme.
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This shows the volume of services provided by primary level facilities in the front runner districts (Marondera and Zvishavane) from July 2011 to August 2012. The services provided are on an increase mainly due to removal of user fees, availability of commodities etc.
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The chart shows the volume of secondary services provided for RBF subsidised indicators from July 2011 to Aug 2012. There was an overall decline over the past year. This can be attributed to the fact that at the beginning of the programme there were too many unnecessary referrals from the clinics to the hospital. This mainly happened on institutional deliveries in Zvishavane, where at the beginning of the RBF programme all deliveries were being done at the hospital. As the number on deliveries at the hospital decreased, they increased at the rural health centre level, due to the improved capability of clinics to conduct deliveries.
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This is based on the verified absolute totals for 4 secondary indicators for the hospitals including hospitals that provide both primary and secondary services. There was and increase in the volume of services in June 2012, this was caused by the extension of a contract for the provision of primary services to that did not have a primary level facility within 5 km. This meant that no referral letter was needed for the payment by RBF on the 4 indicators. These hospitals also double as a clinic.
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Deliveries at the hospitals have gone down while at the rural health centres they have gone up. RBF has been able to improve RHC’s to conduct deliveries and the hospitals now focus more on referred high risk pregnancies.
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The number of institutional deliveries has increased in both rural health centres and hospitals, mainly due to the removal of user fees for MCH services and on job training on midwifery skills to RHC nurses.
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The number of OPD consultations increased over time mainly due to the removal or reduction of user fees, Improvement in in services provided. Fluctuations on different moths can be attributed to health seeking behaviours that are also affected by seasonal changes in most rural areas.
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There is a slight increase in the OPD attendance and is foreseen to increase over time as seen in the front runner districts.
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There is an overall increase in the number of children who completed the primary course of immunisation which encompasses the following vaccines: BCG, OPV1‐3, Pentavalent 1‐3 and measles. New vaccines were introduced in June 2012, rotavirus and pneumococcal, these were not included in the analysis, these will be included in 2013 as this is when children who got these vaccines with be completing their primary course of immunisation. At the beginning of the programme in the first quarter there was a 100%+ jump, this can be mostly attributed to improved data capturing and recording for this indicator, which was poor before the RBF programme began.
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The same reasons as those for the front runner districts also apply
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The number of women accessing modern family planning methods has on average increased. Short term methods include oral contraceptives (POP and COC’s). Long term methods include implants and intrauterine devices. Condoms are excluded
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Like in the front runner districts the number of women accessing family planning services has gradually increased.
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Average quality scores for the front runner districts per quarter. From July 2011 to Sept 2012. All the scores were above 60%, with some as high as 80%. There is need to improve on the quality checklist to include new areas of focus as it seems health facilities are managing to keep good standards on some areas that are currently being supervised. The tools were also revised twice during this period and also at the beginning supervisors were very lenient.
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Most of the health facilities had a quality score above 70%
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In the front runner districts the 54% of the subsidies paid went to the hospitals and 46% to the rural health centres. This is still far from the 60:40 ratio for RHC: hospital, this is mainly caused by the fact that some hospitals are still offering services that can be offered at a RHC. Also the pricing structure also contributed and it has been revised to channel more money to the RHC’s.
In the new districts the safe trend is also noticed
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RBF subsidies have contributed a lot to the improvement of services at contacted health facilities. They have done minor renovations, improved water and sanitation systems, furniture for the delivery rooms & waiting mothers shelter, medical items. Some have used the fund to conduct outreach activities to reach more clients. The working environment has improved as the health workers are more motivated by the fact that they are now able to make decisions on how to run the health facility and they have the funds to use. The government has shown great commitment to support the health facilities to improve further and are taking ownership of the programme.
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RBF subsidies have contributed a lot to the improvement of services at contacted health facilities. They have done minor renovations, improved water and sanitation systems, furniture for the delivery rooms & waiting mothers shelter, medical items. Some have used the fund to conduct outreach activities to reach more clients. The working environment has improved as the health workers are more motivated by the fact that they are now able to make decisions on how to run the health facility and they have the funds to use. The government has shown great commitment to support the health facilities to improve further and are taking ownership of the programme.
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Zvishavane hospital maternity wing was tiled using RBF subsidies. Clinics were also able to construct toilets, incinerators, ottoway pits and many other things.
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The government has shown great commitment to support the health facilities to improve further and are taking ownership of the programme. National budget included 1 million for RBF. HTF adopts RBF principles. The urban poor have to be included in the programme.
There are some delays in getting reports from other health facilities due to logistical challenges and location of some of the health facilities. Shortage of staff and inadequate equipment, some hospital theatres are not functioning. There is need to link the RBF data base to the national HMIS so that verified information can be used to correct data in the national HMIS.
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Zimbabwe is committed to eliminate new Paediatric HIV infections by 2015 i.e reducing new Paeds infections by 90% and a MTCT of HIV to < 5%.
PMTCT Coverage: • Increase in % of HIV + women receiving ARV prophylaxis from 84% in 2010 to 98% in
2011• HIV exposed infants on ARV prophylaxis rose from 74% in 2010 to 94 % in 2011• Rapid expansion with 95 % (1560) of the facilities in the public sector offering PMTCT
servicesMajor Partners: NAC, USG, EGPAF, WHO/CIDA, GF, CHAI, MSF
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ART‐ significant scale up coverage from 26% in 2008 to 78% in 2012; AIM is to achieve UA for adults by end of 2012Key success factors‐use of standard & simplified treatment guidelines‐decentralization of ART centres from 7 in 2004 to nearly 955 health facilities; ‐use of standard training curriculum‐effective partnershipsMajor Partners: NAC, USAID, CDC, GF, DfID, JSI
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